Provider Demographics
NPI:1740371145
Name:WYOMING NEUROLOGIC ASSOCIATES LLC
Entity type:Organization
Organization Name:WYOMING NEUROLOGIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHEEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-265-4343
Mailing Address - Street 1:2546 E 2ND ST STE 600
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2063
Mailing Address - Country:US
Mailing Address - Phone:307-265-4343
Mailing Address - Fax:307-234-6339
Practice Address - Street 1:2546 E 2ND ST STE 600
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2063
Practice Address - Country:US
Practice Address - Phone:307-265-4343
Practice Address - Fax:307-234-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7035A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121198600Medicaid
WY20241Medicare ID - Type Unspecified
I28304Medicare UPIN